Provider Demographics
NPI:1902591373
Name:MARQUEZ GONZALEZ, GEIDY
Entity Type:Individual
Prefix:
First Name:GEIDY
Middle Name:
Last Name:MARQUEZ GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17210 NW 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4422
Mailing Address - Country:US
Mailing Address - Phone:305-776-9979
Mailing Address - Fax:
Practice Address - Street 1:17210 NW 43RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4422
Practice Address - Country:US
Practice Address - Phone:305-776-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty